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OBJECTIVES/GOALS: Physical therapy (PT) is key for treating functional decline that inpatients experience but is a constrained resource in hospital settings. The Activity Measure Post-Acute Care (AM-PAC) score is a mobility measurement tool that has been used to define misallocation of PT. We aim to optimize PT referrals using AM-PAC-based clinical decision support . METHODS/STUDY POPULATION: We conducted a prospective study of patients admitted to University of Chicago Medical Center. AM-PAC scores were assessed by nursing staff every 12 hours. Clinical decision support was designed using validated AM-PAC cutoffs (> 18, a predictor of discharge to home). The tool was embedded in hospital medicine note templates, requiring providers to indicate PT referral status based on current AM-PAC scores. The primary outcome, unskilled consult , was defined as PT referral for patients with AM-PAC > 18. Data were collected for one year prior to implementation and one year after implementation for intervention (hospital medicine) and control (general internal medicine) services. Difference in differences analysis was used to assess the association between the intervention and unskilled consults. RESULTS/ANTICIPATED RESULTS: Between October 2018 and March 2021, 18,241 admissions were eligible for the study. Compared to preintervention, there was a lower rate of referral to PT for patients with high AM-PAC mobility scores in the post-intervention period [18.5% vs 16.6%; X2(1) = 7.02; p < 0.01]. In the postintervention time period, the control group experienced a 2.6% increase in unskilled consults while the intervention group experienced a 2.3% decrease, a difference in differences of 4.9% (95% CI -0.07–-0.03 for difference in differences) controlling for age sex, race, LOS, and change in mobility. Compared to preintervention, there was no statistically significant difference in mean change in mobility score post-intervention for either group. DISCUSSION/SIGNIFICANCE: Our results suggest that clinical decision support can decrease unskilled PT consults. Many functionally independent patients can mobilize with nursing or other mobilization staff. Hospitals should consider mobility score-based decision support to prioritize PT for impaired and at-risk patients.
ABSTRACT IMPACT: This work underscores the importance of judicious utilization of inpatient therapy services as a means to keep patients MORE independent and prevent readmissions OBJECTIVES/GOALS: We aimed to assess the potential over-utilization of physical therapy consults on a hospital medicine service using validated Activity Measure Post Acute Care (AM-PAC) score cutoffs. METHODS/STUDY POPULATION: We conducted a chart review of all patients admitted to the uncovered hospital medicine services at a large academic hospital for one year. For patients who had a PT consult at any time during their admission we obtained age, admission AMPAC score, and discharge destination. PT consults were considered ‘potential overutilization’ for AMPAC scores >/=19 based on previous studies validating this cutoff for predicting discharge to home. Descriptive statistics were used to summarize % of patients < 65 years old vs. >/=65 years and % of patients discharged to home vs. post-acute care. Multivariable logistic regression was used to examine independent associations between age group, AMPAC group, and an interaction term (age group x AMPAC group) with odds of being discharged home. RESULTS/ANTICIPATED RESULTS: Of 6,634 patients admitted during the year, 58% (n=3582) had a PT consult. Mean age was 66.3 +/-15.4 and mean AMPAC was 18.3 +/- 5.3. Seventy percent were discharged home (N=2497). Using AMPAC of >/= 19, 55% of consults were ‘potential overutilization’. Patients <65 with AMPAC>19 represented 31% of PT consults. AMPAC>19 had increased odds of discharge home (OR 3.58 [95% CI=2.17 -5.91]; P<0.001) as did age <45 years (OR 1.81 [95% CI=1.09-3.00]; P=0.02). A significant interaction existed between all ages and AMPAC>/=19 (For age<45 OR 2.85 for discharge home [95% CI=1.37 -4.30] P=0.002; For age 46-64 OR 2.43 for discharge home [95% CI=1.37-4.34] P=0.002). Combining age with AMPAC>/=19 had additional predictive value for discharge home (Pr=89% [95% CI 81%-97%] using age<45 vs. (Pr=83% [95% CI 77%-90%]) using age<45 alone. DISCUSSION/SIGNIFICANCE OF FINDINGS: Many PT consults may represent potential over-utilization. Avoiding these could save hundreds of PT hours per year by conservative estimate. Combining age with AMPAC scores can help predict who may not require a PT consult. Reallocating PT resources to the patients who do require it can help prevent functional decline and readmissions.
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